According to an agreement of countries in the Commonwealth of Independent States (CIS) to cooperate on labour migration and social protection of migrant workers (from 1994), medical services in the host country are provided to migrant workers at the expense of the employer.

Migrant workers working in the informal sector or those with informal job are not included in this agreement because they don’t have a regular employment contract; employers hire them informally and as a consequence do not pay for their medical insurance. Therefore informally employed migrant workers don’t have access to healthcare benefits when they are working in Russia or in any other CIS country.

In 2005, Russia agreed (in the Decree of the Government of Russian Federation #546) that emergency medical care will be provided to foreign citizens (staying permanently or temporarily in the Russian Federation) for free and immediately. This implies that every migrant worker from a CIS country, with or without a working permit, can at least receive emergency medical care for free in Russia.

As we mentioned in our previous blog post, the quota system makes it more difficult for migrant workers to obtain work permits, and thus encourages them to work in the informal sector, where healthcare insurance is not paid by their employers.

Informally employed migrant workers face a high risk of injury or getting sick. With no legal employment contract they can easily be asked to work longer hours, they are not entitled to sick leave, so they probably don’t get enough rest even if they are sick.

For security reasons and to save money, migrants working in the construction sector may choose to live at the construction site where they work, sleeping in the yard and living in very poor hygienic conditions.

In 2011, CIS countries drafted a new agreement to cooperate on health insurance for migrant workers and their families. This document could serve as the legal basis for providing health care to migrants and their families in the CIS.

The agreement applies to all migrants regardless of their legal status and says that the parties agreed to create and implement a common system of medical insurance in the CIS for migrant workers and their families.

They proposed to elaborate accessible forms of medical insurance for migrant workers and their families, including the possibility that the insurance costs for working migrants and their families is partially or fully reimbursed by the employers in the host country.

Although this is a strong and admirable commitment from the countries involved, it seems like it would be difficult to implement. The largest share of working migrants in the CIS is in Russia and many of them are working without a work permit. These people are the ones most in need for medical support (as the migrant workers legally employed have health insurance).

In order to use the “right to health insurance” guaranteed to all migrant workers in the agreement, an unregistered migrant worker would probably have to apply for health insurance and prove that he is a working migrant. This would mean revealing his or her illegal working status.

This could have serious consequences, including loss of a job, or deportation. The incentives for businesses in the host country is also not clear: why should they fully or partly refund the costs for healthcare insurance? One of the biggest incentives to hire migrant workers without a formal contract is that it is relatively cheaper for the employer (no taxes, lower salaries, no social contributions or health insurance).

Maybe we need to think outside of the box to find a solution to what looks like a vicious circle: quotas mean more informal work, informal workers don’t have a regular contract so they don’t have health insurance, and the right to universal migrant healthcare can be exercised only by proving you have a legal job. It doesn’t seem a realistic solution.

Are you aware of a similar case in another region of the world? What was done to address the issue? Can this solution also be implemented in the CIS?